Provider Demographics
NPI:1558387639
Name:SUMMIT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SUKENICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:570-839-8818
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-0627
Mailing Address - Country:US
Mailing Address - Phone:570-839-8818
Mailing Address - Fax:570-839-9140
Practice Address - Street 1:ROUTE 940
Practice Address - Street 2:POCONO SUMMIT PLAZA
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-0627
Practice Address - Country:US
Practice Address - Phone:570-839-8818
Practice Address - Fax:570-839-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013626L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6194920001Medicare NSC